Is My Skin Purging or Breaking Out? How to Tell the Difference

Purging usually shows up as small spots in the places you normally break out, within the first few weeks of starting a retinoid such as adapalene or an exfoliant such as salicylic acid, and it settles as your skin adjusts. A reaction looks different: redness, burning, stinging, itching, peeling or bumps, often in places you never get spots, and it doesn't settle or gets worse. If it looks like a reaction, stop the new product and go back to a simple routine.

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This is general information, not medical advice. If a problem persists, gets worse, or you're unsure what you're seeing, see a GP, pharmacist or dermatologist.

What "purging" means

"Purging" is the word people use for a short spell of extra spots after starting a product that speeds up how quickly skin cells turn over. Retinoids are the main example, and exfoliating acids are sometimes blamed too. The idea is that blockages already forming under the skin come to the surface faster than they otherwise would.

It's worth knowing the evidence here is less settled than social media suggests. A 2009 review in the Journal of Drugs in Dermatology, Do Topical Retinoids Cause Acne to "Flare"?, found no clinical trial evidence that topical retinoids cause acne to get worse when you start them, and suggested that early worsening may often be the normal ups and downs of acne. So don't assume every new spot is a "purge" you just need to push through.

How to tell them apart

Look at three things: where the spots are, what they look like, and how they change over time.

It's more likely to be purging if:

• The spots appear in the areas where you usually break out.
• They're small spots or whiteheads that seem to come and go faster than usual.
• They started within a few weeks of beginning a retinoid or exfoliant.
• They're gradually easing rather than spreading.

It's more likely to be a reaction or irritation if:

• Your skin is red, raw, burning, stinging or itchy.
• You have a rash, peeling patches, or lots of tiny bumps.
• It appears in places you never get spots.
• It started within days and isn't settling, or it's getting worse.

The NHS notes on acne treatments that mild irritation and stinging are the most common side effects of topical retinoids. A little dryness or tingling while your skin gets used to a product is common, but ongoing burning, a rash or raw skin is a sign to back off, not push on.

What to do if it looks like purging

1. Keep the routine simple. A gentle cleanser, a moisturiser and sunscreen in the morning, with your one active at night.
2. Don't add anything else. Starting two actives at once makes it impossible to know which one is causing what.
3. Keep the same frequency. If you're using a retinoid two or three nights a week, stay there rather than jumping to every night.
4. Moisturise and wear sunscreen daily. Retinoids can make skin more sensitive to the sun, and the NHS advises avoiding excessive sun and UV exposure while using them.
5. Hands off. Picking and squeezing push inflammation deeper and can leave longer-lasting marks.

What to do if it looks like a reaction

1. Stop the new product. Go back to a plain cleanser, moisturiser and sunscreen until your skin calms down.
2. Avoid scrubs, harsh soaps and DIY remedies such as lemon juice, toothpaste or baking soda, which irritate already sensitive skin.
3. Reintroduce slowly, if at all. Once your skin is calm, you could try the product less often, or ask a pharmacist about a gentler option.
4. Get help promptly if you have swelling, a spreading rash, blistering, or skin that isn't settling. A pharmacist or GP can advise.

How long is too long?

Acne treatments are slow. The NHS says many treatments can take 2 to 3 months before they start to work, so judging a product after a fortnight is too early. A common guide is that any purge should be settling within roughly four to eight weeks of starting a new active.

If spots are still getting worse after that, or are spreading to new areas, it's no longer reasonable to call it purging. Stop and review the routine, and speak to a pharmacist or GP.

When to see a GP or dermatologist

Over-the-counter care is enough for many people with mild spots, but see a GP if:

• Your acne is moderate or severe, or pharmacy treatments haven't helped after a consistent trial.
• You have deep, painful lumps under the skin.
• Spots are leaving scars or marks are building up.
• It's affecting your mood or confidence.
• You have something that doesn't look like acne, such as a rash, a patch that won't heal or a changing mole.

The NHS notes that a GP can refer you to a dermatologist for severe acne, painful nodules or scarring. Adapalene and tretinoin are prescription-only in the UK, and topical retinoids aren't suitable during pregnancy, so always check with a pharmacist or doctor before using one. If you're under 18, on medication or have a diagnosed skin condition, ask before adding any active.

Key takeaways

• Purging tends to be small spots in your usual areas, starting soon after a new retinoid or exfoliant, and easing over a few weeks.
• Irritation means redness, burning, itching, peeling or rash, often in new areas, and it doesn't settle.
• Evidence that retinoids cause a "purge" is limited, so don't push through anything that feels wrong.
• Start one active at a time, keep the rest of the routine plain, and wear sunscreen daily.
• See a GP, pharmacist or dermatologist if things get worse, spread or don't improve.

The skin chapter of Glow up Protocol walks through building a simple routine and introducing one active at a time, which makes it far easier to tell what each product is doing.

FAQ

Can a moisturiser or cleanser make you purge?

A product without an active that speeds up cell turnover isn't expected to cause purging. If a new moisturiser, cleanser or sunscreen is followed by spots, it may simply not suit your skin, so try stopping it and see whether things settle.

Should I stop using a retinoid if I get spots?

Not automatically. A few small spots in your usual areas can be part of the adjustment period. But if you get burning, a rash, raw skin or spots in new places, stop it and speak to a pharmacist or GP.

Does purging mean the product is working?

Not necessarily. Some people see no purge and still improve, and others see spots that turn out to be ordinary breakouts or a reaction. Judge a product on how your skin looks after a consistent trial of a few months, not on the first few weeks.

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